15-09 Story 2: Addiction: Why it happens and how to help addicts back from the edge

 

Synopsis: Millions of Americans are addicted to alcohol and drugs, and many of them end up unemployed, broken away from their families and homeless. We talk to a psychologist about the causes of addiction, and why some people are more likely to fall to it than others, and find out how an author who is battling alcohol and drug addiction made his journey to sobriety, and the lessons he learned on the way.

Host: Marty Peterson.  Guests: Ryan LaLumiere, psychologist, Assistant Prof. in the Psychology Dept., University of Iowa, and a specialist on addiction; Bob Allison, recovering addict, author of “Saved by the Prince of Peace: Dungeon to Sky.”

Links for more info:

Understanding Addiction

Marty Peterson: Drug and alcohol addiction are major health problems in the United States these days, and it crosses all demographics – from the wealthy who seem to have everything, to the poor and the homeless. Why is it such a problem? And what can we do about it? To answer those questions, we need to find out just what addiction and substance abuse are. Ryan LaLumiere is an assistant professor in the psychology department at the University of Iowa, and a specialist in the neurobiology of addiction. He says that addiction is a complex condition…

Ryan LaLumiere: Addiction really involves three basic characteristics with regard to drugs of abuse. One is the compulsion to seek and take the drug; the second is loss of control over use of the drug; and the third component is a negative emotional state when you cannot access the drug. And together those three characteristics really help to define drug addiction.

Peterson: He says that there is a genetic component to the disease of addiction as well…

LaLumiere: There have been a number of a number of studies that have especially, for example, twin studies, that look at what we call the “heritability component,” and there is a significant heritability component to drug addiction. It doesn’t necessarily mean that it’s specific to a particular class of drugs. It appears for most of the studies that it cuts across classes of drugs of abuse. So there is good evidence, in fact, that genetics does play a role in whether you are likely, A, to start taking a drug of abuse, and B, become addicted to that drug. Now at the same time, it’s also important to note that there are significant environmental factors, social factors, cultural factors that may also play a role in both the initiation of drug use as well as addiction.

Peterson: LaLumiere says that there is also a link between other psychiatric disorders and addiction…

LaLumiere: There is a great deal of what we call “co-morbidity” between addiction and a number of other psychiatric disorders including bipolar disorder, depression and anxiety disorders. So what he is describing is actually quite common and is a major impediment to the treatment of drug addiction as well, because you don’t need to just treat the addiction but you also need to deal with the other disorders that the person may have.

Peterson: LaLumiere says that people who have a family history of substance abuse or those with a psychiatric disorder don’t necessarily become abusers themselves. There are outside factors that can cause a person to turn to drugs or alcohol to relieve the strain…

LaLumiere: There’s been a tremendous amount of research looking at the interactions between stress and drug addiction and show there’s a big relationship there in a number of different ways. We know, for example, chronic stress early in life can alter the brain systems that are involved in reward and may make you more susceptible to drug addiction. They can also make you relapse back to drug addiction, so people who had been drug addicts and were trying to stay clean, stressors in their lives can precipitate them to go back to using drugs. So just as one example, stress absolutely plays a huge role. So when we talk about these other kinds of factors there can be both chronic factors, psychiatric disorders but also acute factors going on in a person that will influence both the development of addiction as well as the potential relapse back to using the drugs.

Peterson: The combination of heredity, a psychiatric disorder and the disease of substance abuse itself is what plagued Bob Allison. He’s a recovering abuser and author of the book, “Saved by the Prince of Peace: Dungeon to sky.” Allison says his story is one of long-term drug and alcohol abuse that led him into the depths of darkness…

Bob Allison: I was living in a utility closet, electrical closet, in an alley, behind my favorite bar. I could open the door with a plastic comb. When I stepped inside I could lock that door with a pushbutton on the doorknob. And that was prime real estate when you’re homeless. At the end of my journey, I was so beat up physically, mentally, spiritually and emotionally – I had already had pancreatitis – I was very weak. I was terrified. I could feel death breathing down the back of my neck. People were dying around me. They were killing homeless people in Denver at that time. And I was actually attacked by a man with two butcher knives when I was sleeping down at the river with my dog.

Peterson:   Allison had been to 13 treatment centers for his addictions, but nothing worked until he “hit bottom”…

Allison: I’m in that closet I wake up one morning, I’m feeling overwhelmed and terrified, and I say one single prayer, “Jesus please help me.” Two or three days later I’m sitting in Hazelden Foundation, one of the top chemical dependency treatment centers in the country. And I’m sitting with a group of 25 other addicts sitting in a circle talking about our experiences. And to me that was a major, major miracle. My family helped me get from homelessness in Denver to Minnesota to go the treatment. I agreed as part of my surrender to go to nine months of treatment. And believe me I needed it. I was in such bad shape. I was on the edge of death and my health was terrible.

Peterson: Allison credits his sobriety to Jesus and the help of his family in getting him to that final rehab center. He says that part of the problem with his continued addiction was that he had a “dual diagnosis” that wasn’t addressed…

Allison: What that means is in my case I was an alcoholic and an addict, but I was also manic-depressive. I first diagnosed in 1982 but I was in denial, did not accept that I had a mental illness, so that’s one of the reasons I went to 13 different treatment centers. I could not stay sober because of the mania in my life. So if you have a dual diagnosis, it’s really key to get treatment for both conditions – both the addiction and the mental illness.

Peterson: Many people who have alcohol abuse problems and drink throughout the day can function quite well in their daily lives. Sometimes no one outside the family and maybe some close friends even knows that they’re alcoholics. Ryan LaLumiere says that for these individuals, it’s a matter of building up a tolerance to drink…

LaLumiere: We know that people who are chronic alcohol drinkers can metabolize alcohol a bit more quickly, but also their brains show less responsiveness to it. And this is actually part of the problem with addiction because what ends up happening is that in order to achieve the same level of intoxication, they have to consume more. So it actually helps to progress the whole process of addiction. So some of these people, quite frankly, have probably been able to become tolerant to some of the alcohol, and are able to work around some of the negative effects. Nonetheless, if somebody were drinking to get up in the morning, as well as a few drinks during the day, if we were to measure them, a number of characteristics these people compared to normal control subjects, we’d see that these people were in fact impaired in a number of ways, even if they are able to maintain some level of basic functioning.

Peterson: Bob Allison is worried about the slow spread of the tolerance for and legalization of marijuana. He says that it’s a “gateway” to more severe problems in the future…

Allison: I feel very strongly about this because you know I’m a recovering addict of 16 years, and for me in my story, that started with marijuana in high school. Absolutely it was a gateway drug. Now everyone handles chemicals differently, but I can tell you this whole legalization of marijuana, like out in Colorado now, I think that’s a big, big mistake. Because what’s happening is young people, teenagers, are actually leaving their homes, all across the country, and they’re headed for Colorado with the thought “I can go buy marijuana legally.” And they go out there, and then they get involved in the drug culture. More than likely they’re going to end up homeless, living, you know in camps, in groups of homeless people, and drug addicts and alcoholics, and they can be exposed to a whole lot more than marijuana.

Peterson: The idea of “gateway” drugs has been studied, and LaLumiere says that there’s no evidence so far that shows a link…

LaLumiere: There’s been a lot of research looking at the idea of a gateway hypothesis, and the idea, of course of the gateway hypothesis is that the use of one drug then actually makes you more likely to become addicted to other drugs. And the research on that hypothesis suggests that is not the case. Rather, what people believe is, and what the evidence suggests is that there is a thing called a “common addiction liability.” That is, it doesn’t matter what drug you start taking first, just that certain people have predispositions to using drugs and to becoming addicted to drugs regardless of the class of drugs.

Peterson: No matter what the substance that’s abused is, why is it that some people can reach sobriety and others can’t? Allison says it’s often a case of the addict losing hope that he or she will ever be able to stop. Isolation from others is also a factor…

Allison: A man or a woman might be living alone, in a lonely apartment someplace, going to work, they might be a functional alcoholic, and they do great at work, super hard worker. So this person comes home to their lonely apartment and they drink themselves half to death until 5 o’clock in the morning, and then they get up the next day and they go to work, and they repeat that cycle. So that’s a lifestyle change that needs to be changed: isolation. We need friends, we need to be loved. You know we need physical exercise, we need a good nutrition plan. But if a person has crossed over the edge of addiction, they’re on a train that’s a journey, it’s a destination that goes from Point A to Point B. Point A is when you first pick up the drugs or alcohol, and Point B is death. So, I mean you have to get off the train and you gotta get help to do it. Believe me, I did not get sober on my own.

Peterson: The support of family and friends is important for many addicts seeking help, but LaLumiere says that it’s ultimately up to the substance abuser to make the decision…

LaLumiere: Because so much of it depends on the individual, and depends on their willingness to accept whether they have a problem or not. It’s very difficult to reach somebody does not acknowledge that they are having a drug addiction. So that I think when it comes to families and friends, one of the things you want to do, of course, is make sure you don’t continue to enable the drug addiction, and to provide that kind of both firm and loving support for the person. But at the end of the day, it’s very difficult for other people to solve this person’s problem. And I think that’s an important lesson for family and friends to remember, is that they cannot solve the problem for the person. If the person isn’t willing to be a participant in the treatment, they’re not going to have a great deal of effectiveness when treating them.

Peterson: So what are the best treatments for people addicted to drugs or alcohol? It’s hard to say, since everyone is different. LaLumiere says that one key to success is providing treatment that supports the addict for the long-term…

LaLumiere: This is a fundamental problem that we have in addition treatment: that we don’t have a lot of good, effective treatments. We have a lot of what we call cognitive behavioral therapy-based treatments, where we put people into rehab, we get the clean, we try to talk with them about the issues that were leading to their drug use and why drug use is problematic. And we can certainly get people to be clean for a month, two months, get them past any withdrawal symptoms. But the fundamental problem is that we face a very high rate of relapse. If you follow people up to six months later, 12 months later, a large percentage of them – and this is across all the drugs of abuse – a large percentage of them relapse back to their drug use. And we certainly don’t have any single treatment that works across all the drugs of abuse. We have a number of treatments of course, for example, opiate addiction such as methadone. But none of these are magic bullets, none of these have tremendously high rates of effectiveness. The best treatments really combine as many possible modes of treatment as we can, and provide long term support for people.

Peterson: There a number of online resources to find out more about addiction and treatment options. You can log onto the substance abuse and mental health services administration site at find treatment.samhsa.gov for a state-by-state facility finder. Bob Allison invites listeners to pick up his book, “Saved by the Prince of Peace,” to read about his journey from addiction to sobriety, and visit his website at dungeontosky.com. To find out more about Ryan LaLumiere and his work, visit psychology.uiowa.edu. And you can always find out more about all of our guests on our site at viewpointsonline.net. Our show is written and produced by Pat Reuter. Our production directors are Sean Waldron, Reed Pence and Nick Hofstra. I’m Marty Peterson.

 

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